Sketchy Path: Chronic Kidney Disease

Question 1

What two tests are most commonly used to assess chronic kidney disease progression?

Answer 1

• Creatinine as a surrogate for GFR (like the empty coffee machines that accept CREDIT CARDS)
• Albuminuria (like the cracked album that’s gonna leak some photos)

Question 2

Chronic kidney disease is defined as elevated creatinine or albuminuria for at least ___________.

Answer 2

3 months (like the three-month expedition photo album)

Question 3

The two most common causes of CKD are _____________.

Answer 3

diabetes and HTN (like the fuming kid kicking the candy machine near the gift shop)

Glomerulopathies and ADPKD can also lead to CKD (like the frayed red glomerular knots and balloons in the gift shop).

Question 4

Why do diabetes and HTN lead to CKD?

Answer 4

Both disorders occlude the microvasculature.

Question 5

Bilateral ____________ can lead to CKD.

Answer 5

renal artery stenosis (like the girl with the two purses held up by tight red straps)

Question 6

Recurrent ____________ can cause CKD.

Answer 6

pyelonephritis (like the bumpy pineapple)

Question 7

Explain the overall pathogenesis of CKD.

Answer 7

The initial insult injures some nephrons. The uninjured nephrons adapt by increasing their filtration load. They can maintain GFR for some time, but the overworking eventually damages them, too.

Question 8

CKD can lead to metabolic _____________.

Answer 8

acidosis (like the bubbly acid volcano) due to impaired excretion of uric acid and impaired resorption of bicarbonate

Question 9

The metabolic acidosis from CKD can worsen the hyper-___________.

Answer 9

kalemia, because the body shifts acid into cells in exchange for potassium (like how the banana trees are right behind the volcanos)

Question 10

Failure to excrete ____________ leads to pulmonary edema and peripheral edema.

Answer 10

sodium (like the soaking wet cave man)

Question 11

________________ are often seen in the urine of those with CKD.

Answer 11

Waxy casts (like the wax arm floating in the water), although these aren’t specific

Question 12

CKD can worsen _______________.

Answer 12

HTN (like the geyser behind the cave man)

Question 13

CKD causes ___________ anemia.

Answer 13

normocytic (due to decreased EPO)

Question 14

By what mechanisms does CKD lead to osteodystrophy?

Answer 14

• Hyperphosphatemia from decreased GFR leads to hypocalcemia because phosphate binds calcium (girl grabbing P’s spills ice cream)
• Hyperphosphatemia leads to induction of a protein called FGF23 that inhibits vitamin D (falling D in dino sign)
• Decreased production of vitamin D due to faulty 1-alpha hydroxylation
• All of the above lead to activation of PTH (secondary hyperparathyroidism). The PTH then stimulates too much periosteal bone resorption which produces osteitis fibrosis cystica (like the PHd running to grab the mischievous girl and leaving his fossil).

Question 15

Osteitis fibrosis cystica leads to ______________ in bone.

Answer 15

“brown tumors” –just cystic space (think of the brown holes in the PHd’s fossil)

Question 16

______________ is more common than osteitis fibrosis cystica.

Answer 16

Osteomalacia (like the bones found in Malaysia)

Question 17

What are symptoms of uremia?

Answer 17

• Asterixis (shaking bird)
• Vomiting (bird vomiting into baby bird’s mouth)
• Platelet dysfunction (like the cracked red plates on the Stegosaurus)
• Pericarditis (like the red covering on the dino eggs)
• Encephalopathy with confusion or coma (dino with red head)
• Pruritus (little guy scratching his back on the dino)

Question 18

CKD is an independent risk factor for _____________.

Answer 18

CAD (like the cave man with the red, atheromatous crown in the back)